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NAM aidsmap

18th Conference on Retroviruses and Opportunistic Infections, Boston, 27 February-2 March 2011


HIV treatment: transmitted resistance

There is increasing evidence of the transmission of HIV strains with resistance to anti-HIV drugs in low- and middle-income countries.

Research in eleven sub-Saharan African countries showed that the chances of detecting transmitted resistance increased by over a third each year that a country had been scaling up HIV treatment.

A separate study involving people recently diagnosed with HIV in Kampala showed that approximately 9% were infected with virus that was resistant to at least one anti-HIV drug.

In Central and Latin America, rates of transmitted resistance were also rising – as high as 7% in Mexico and 20% in some parts of Brazil.

World Health Organization research showed that some African countries were struggling to provide the level of HIV care needed to reduce the risk of resistance. Drug stocks often ran low, there was a high rate of loss to follow-up, and patients frequently did not collect their treatment on time.

HIV treatment: once-daily raltegravir

Taking raltegravir (Isentress) once daily results in poorer outcomes than twice-daily treatment with the drug in patients starting HIV treatment for the first time.

Patients taking the once-daily dose were less likely to suppress their viral load to undetectable levels.

Raltegravir is an important new treatment option, especially for people who have taken a lot of HIV therapy in the past.

It’s approved to be taken twice daily.

However, its main competitors are once-daily therapies, and some research suggests that patients find more frequent dosing less convenient, leading to poorer adherence, and therefore a reduced chance of suppressing viral load.

A study was therefore designed to check the safety and effectiveness of once-daily dosing of raltegravir. It involved 770 patients starting HIV treatment for the first time. They were randomised to receive raltegravir doses of either 800mg once daily, or 400mg twice a day. The patients also took Truvada (FTC/tenofovir).

After a year of treatment, 83% of patients taking the once-daily treatment had a viral load below 50 copies/ml, compared to 89% of those taking twice-daily treatment.

Once-daily raltegravir performed especially badly in patients who had a baseline viral load above 100,000 copies/ml. Only 75% of these people achieved a viral load below 50 copies/ml, compared to 84% of those taking the drug twice a day.

Lower levels of raltegravir in the blood were seen in people taking once-daily treatment.

The researchers therefore concluded that treatment with once-daily raltegravir was inferior.

Side-effects: bone loss

Study presenter Ighovwerha Ofotokun at CROI 2011. Photo by Liz Highleyman / aidsmap.com

Changes to the immune system soon after HIV treatment is started seem to be associated with bone loss, a small study suggests.

Bone density loss is now a recognised side-effect of HIV treatment. The exact causes are unknown, as are the long-term clinical consequences.

US researchers focused on changes to the immune system in the first twelve weeks after starting HIV therapy. Many patients experience a considerable recovery in their CD4 cell count at this time. Immune activation has been associated with bone loss in HIV-negative patients.

Their study involved 20 patients starting treatment for the first time. All responded well to therapy and, after six months, 19 had an undetectable viral load.

However, blood tests monitoring biomarkers of bone formation showed that there was bone loss during this period.

There was an especially dramatic surge in bone resorption (loss or reassimilation of bone) in the weeks immediately after HIV therapy was started. The investigators commented that the change was similar to that seen in menopausal women.

Bone loss peaked twelve weeks after starting treatment.

An animal study had similar results and showed that bone loss was accompanied by immune reconstitution.

The researchers think that their findings could have implications for HIV care, and that treatment to prevent bone loss may be appropriate during the early stages of antiretroviral therapy.

HIV and hepatitis C: telaprevir works well

Study presenter Mark Sulkowski at CROI 2011. Photo by Liz Highleyman / aidsmap.com

The hepatitis C protease inhibitor telaprevir seems to works well in people co-infected with HIV and hepatitis C.

The experimental drug was used in combination with established hepatitis C therapy consisting of pegylated interferon and ribavirin.

Telaprevir is known to work well when combined with these drugs in patients who are only infected with hepatitis C. Researchers wanted to see how safe and effective the experimental therapy was in co-infected patients.

Their research had two parts. The first included patients with a high CD4 cell count who were not yet taking antiretroviral therapy.

The second involved people who were taking HIV therapy based on either efavirenz (Sustiva or Stocrin) or atazanavir (Reyataz). These drugs were selected because laboratory tests showed they had a low risk of interacting with telaprevir.

Patients in both parts of the study were randomised to receive either telaprevir or a placebo.

Overall, after four weeks of treatment 70% of people taking telaprevir had an undetectable hepatitis C viral load, compared to only 5% of those taking the placebo.

Results were broken down according to the type of HIV treatment a patient was taking. Undetectable hepatitis C viral load was seen in 75% of people not taking HIV therapy; in 71% of people taking efavirenz-based therapy; and in 65% of people taking atazanavir-based treatment.

However, the small numbers of patients in the study meant that the researchers couldn’t compare outcomes between the drugs.

Blood levels of telaprevir were good, and it had only a modest impact on concentrations of anti-HIV drugs. Treatment with telaprevir did not have an adverse impact on either HIV viral load or CD4 cell count.

The researchers said that they’d be comfortable treating patients who were taking efavirenz or atazanavir with telaprevir.

Clinical trials are continuing.

Prevention: microbicides and PrEP

Image: Thanks to Microbicide Trials Network, University of Pittsburgh and Magee-Womens Research Institute

A study in Africa and the US has reported that US women preferred oral pre-exposure prophylaxis (PrEP) to a vaginal microbicide gel. African women, however, had no preference between the two.

Women in the study were using products containing tenofovir (Viread). They were randomised to take daily oral tenofovir PrEP, use the microbicide gel daily, or to use both.

Vaginal concentrations of tenofovir were highest in women using the gel, but blood concentrations of the drug were higher in those receiving the pill.

Overall, 93% of women said they would use the tablet if they needed to in the future, 83% per cent the gel and 82% both formulations.

Translations from NAM

As well as news coverage and information resources in English, we also provide translated versions of our patient information in 17 other languages.

We provide key conference coverage in French, Spanish, Portuguese, Russian and Romanian. You can already read and download this year's CROI bulletins in these languages.

We have also recently produced translated versions of some of our patient information booklets and our illustrated series the basics as freely downloadable PDFs in 17 languages. There are now more than 170 resources available.

We're very grateful to the HIV organisations, clinicians, translators, funders and HIV-positive people who have shaped this project. Help us make the most of their work, by letting your colleagues, patients and network know that these translations are available.

The full list of languages: Arabic, Czech, Dutch, French, German, Hebrew, Italian, Norwegian, Polish, Portuguese, Romanian, Russian, Somali, Spanish, Swedish, Thai and Turkish.